Toddlers Flashcards
ages 12-36 months
Rate of weight gain decreases (slimmer)
Toddlers
typically are bow legged and have protruding abdomen
12 months
what months should a toddler come to see the Dr?
12, 15, 18, 24, and 30 months. Then 3yr visit at 36 months
What growth chart to use for toddlers?
WHO Growth chart until 2 years old, then switch to CDC growth chart
When does the anterior fontanelle close? Posterior?
Anterior fontanelle closes 18-19 mos
Posterior fontanelle closes 12 months
Average weight 26-28 lbs (remember avg wt is just over the age in months)
Avg height 34-35 inches
Avg head circumference 19-19.5 inches
24 months
(first tooth usually erupts at _____ mos, then add one tooth per month)
6-8 teeth at______ m months
6 months
12 months
Complete set of primary teeth at _______
Second molars usually erupt by _____
24 months
3rd year
Visual acuity at age 2:
20/70
What age?
fine motor development = pincer grasp
12 months
What age?
fine motor development = tower of 4 cubes, imitates scribbling puts blocks in large holes, drinks from a cup, takes off socks,
gross= directed throwing, walks well independently, climbs into adult chair
18 months
What age?
fine motor development = tower of 7 cubes, circular scribbling, folds paper once, puts blocks in large holes, turns doorknobs, turns pages one at a time, unbuttons or unzips large fasteners , puts on coat witha ssistance
24 months
What age?
fine gross development = throws overhand, runs well , kicks ball, walk up and down stairs (places both feet on each step)
24 months
What age?
fine motor development = tower of 9 cubes vertical and horizontal strokes, imitates circles, can button large buttons, uses fork in a fist, twists jar lids
30 months
What age?
gross motor development = jumps off ground with both feet
30 months
What age?
fine motor development = tower of 10 cubes, imitates bridge of 3 cubes, snips with scissors, brushes teeth (not well ), puts shoes on feet
36 months
What age?
gross motor development = broad jumps, walks up stairs alternating feet, pedals tricycle, balances on one foot 2-3 seconds
36 months
What age?
Gross motor= walks w/ one hand held, stands alone momentarily
12 months
At _____ months, 25% of speech is intelligible to strangers
24 months
Communication development is rapid between___________ months
12 and 36 months
receptive language development
what age range?
Follows simple one-step commands, Understands new words weekly, Increased interest in named pictures, Differentiates environmental sounds, Points to familiar objects and body parts when named, Understands simple questions, Begins to distinguish “you” from “me”
12- 18 months
Expressive language development
what age range?
All vowels and many consonants present Increased use of true words Jargon is sentence-like Shows “no” behavior Names a few pictures 10 words Imitates non-speech sounds (click, tongue click, dog bark) Names some body parts
12- 18 months
receptive language development
what age range?
Follows 2-step commands
Rapidly increasing vocabulary
Enjoys simple stories
Recognizes pronouns
18 - 24 months
Expressive language development
what age range?
Imitates 2-word combination Dramatic increase in spoken vocabulary Speech combines jargon and words Names self Answers some questions Begins to combine some words
18-24 months
Expressive language development
what age range?
Jargon reduces 2-3 word sentences Repeats 2 numbers Increased use of pronouns Asks simple questions Joins songs and nursery rhymes Can repeat simple phrases and sentences
24-30 months
receptive language development
what age range?
Undersants prepositions in and on
Seems to understand most of what is said
Understands more reasoning
Identifies object when given function
24-30 months
receptive language development
what age range?
Listens to adult conversations Understands preposition under Can categorize item by function Begins to recognize colors Begins to take turns Understands big and little, boy and girl
30-36 months
Expressive language development
what age range?
Answers questions
Repeats 3 words
Uses regular plurals
Can help tell a simple story
30-36 months
Concrete thinkers
Views the world egocentrically
Language development most sensitive indicator of cognitive development
Toddlers
what to look at for toddler exam?
Eyes: Mouth- abdomen skin - Neuro- Genitalia-
Eyes: ocular mobility, fixate Mouth- dental caries, plaque abdomen skin - bruises normal in toddlers depending on placement Neuro- interactions and mobility Genitalia- testes descended? Labia open?
Screen for early detection Surveillance at every visit (according to AAP, no USPSTF recommendation) ID concerning factors Age 2 or more: refer for EI, ASD evaluation, and audiology Age 1 -18 mos: use screening tool Routine screening at 18 and 24 months MCHAT-R 20 questions for caregiver to answer Scored by HCP f/u questions for areas of concern www.m-chat.org/
Autism Spectrum Disorder
Healthy people goal to eliminate lead levels >= ____ ug/dL; HOWEVER there are no safe lead levels
> =10 ug/dL; HOWEVER there are no safe lead levels
establishes growth of breastfed infants as the norm, provides better description of physiological growth, based on high quality data
WHO growth chart
used up to age 2… then switch to CDC
What PTs focus on?
Gross Motor
What OTs focus on?
Fine Motor
how much the toddler is taking in language?
receptive
Questions to ask about Lead?
Live or regularly visit house with peeling or chipping paint built before 1960?
Renovation or remodeling house built before 1960
Brother or sister treated or followed for lead poisoning? (>= 15 mcg/dL)
Live with adult whose job or hobby involves lead exposure?
Live near active lead smelter, battery recycling plant, or other industry likely to release lead?
When to screen baby for lead? what ages?
1 and 2 12 months Blood test: In high prevalence area Insured by Medicaid In low prevalence area or not on medicaid with positive answer on screening questionnaire
18 months
Lead blood test if no previous screen or change in risk
24 months Blood test: In high prevalence area Insured by Medicaid In low prevalence area or not on medicaid with positive answer on screening questionnaire
What age to screen for Hgb/Hct for all children?
12 months for everyone
15 months → if risk factors
18 months → if risk factors
24 months → if risk factors
30 months → if risk factors
Risk factors:
Low income, WIC eligible
Migrants or refugees
Pre-term or low birth weight
Fed non-fortified formula for 2 months or more
Fed cow’s milk before 12 months old
Breastfed infants with inadequate iron intake from supplemental food after 6 months
Consume more than 24 oz of milk per day after 24 months of age (cow, goat, or soy)
On medications that interfere with iron absorption
Chronic infection, inflammation, restrictive diets, or extensive blood loss
Anemia
screen at 24 months if: parent with dyslipidemia, high-risk conditions, other risk factors
Cholesterol Screening
when to screen for TB?
12 & 24 months→ skin test for any kids with risk factors
Skin test preferred over quantiferon gold blood test until 5 years old
TB risk factors
Recent immigrant/ refugee status from TB common country
Crowded conditions
Family member or close contact with positive TB
important things to know about fevers in toddlers
Most common cause is viral 100.4F or higher (38C) Rectal is gold standard Fever enhanced immunologic response until higher than 104F Adverse effects: Increased metabolic rate Increased fluid loss Increased O2 consumption Increased caloric requirement (may lose weight bc not hungry)
Febrile sz: triggered by rapid rise
Tx if uncomfortable (over 100.5)
ED if higher than 104
Fever unresponsive? ED
None under 12 weeks Avoid multi-ingredient products (cold meds) Dosed by weight, not age Use a syringe for accuracy Repeat q4-6hrs No more than 5 doses in 24hrs Initial drug of choice
Acetaminophen
No use under 6 months
Max daily dose 40mg/kg
Caution with decreased liver function, asthma, or coagulation disorders
Ibuprofen
vomiting red flags
bilious emesis, bloody emesis
Causes: gastroenteritis, GERD, allergies
Concern for dehydration
ID and alleviate cause
Antiemetics not recommended → better out than in
Refer to specialist if persistent or recurring
BRAT diet → banana, rice, apple, teas and toast
Maintain hydration
Oral replacement liquids → small, frequent amounts
Avoid water, juice, soda, sports drinks → more irritating, electrolyte imbalances
Monitor UOP
Vomiting
Both and parent and child should be ready Signs child is ready: Recognized soiled diaper; makes them uncomfortable Interested in toilet Says they want to go potty Understands and follows basic directions Stays dry for 2hrs or longer during day Wakes from nap with dry diaper Can pull pants up and down
Potty training
Knock knees
genu- valgum
“gum makes yoru knees stick together”
bow legged
Genu- varum
“rum makes your knees far apart”
Both are normal in toddler and should resolve on own by age of 3
Provide parental reassurance
Corrective footwear and splinting not recommended
Referral if not improving or affecting ability to walk
Genu- varum
(rum spreads knees apart)
Genu- valgum
(gum sticks knees together)
Causes physiologic, age related Varies with activity and if tired No referrals needed unless: Significant enough to impact mobility Unnatural extension of hip position; corrects with time; reassure parents
In-toeing/out toeing
Common
Require less food, growth rate slowed
Do not push them to eat
16-32oz of milk per day
picky eaters
Dependence vs. independence
Toddler mastering multiple new skills
Teach anger management and conflict resolution
Reinforce positive behaviors
Set clear, concise, and consistent limits
Punishment bad; discipline good
Comfort items helpful provide feelings of safety and security
terrible 2s
12 month old anticipatory guidance
Living situation and food security
Tobacco, alcohol, and drugs
Strengths and protective factors→ support system, taking breaks from the hard work of parenting
Adjustment to developmental changes and behavior → punishment and discipline. The use of distraction.
Family time
Bedtime, naptime, and teeth brushing → 12-14 hours of sleep; set bedtime and routine
Media → no more than an hour per day, research shows it may decrease development
Self feeding should be present → expect a mess
Transitioning to family meals; nutritious foods
Not too much fish with mercury
First dental visit
Car seat safety → rear facing until at least 2; if they do not exceed weight restrictions on seat
Falls
Drowning prevention and water safety → bathtub, pools
Sun protection
Pets
Poisoning
15 month anticipatory guidance
Allow independence and choices to promote individualization
Separation → anxiety is normal
Finding support as the parent; taking breaks
Promote communication watching what you say in front of children
Bedtime routine, night waking, no bottle in bed
Conflict predictors → distract from things that can cause conflict. Accept inconveniences that come with toddler stage
Brushing teeth, preventing caries → let child and parent brush
If parent is prone to caries they can introduce that bacteria to their children if sharing spoons and straws
Parental use of seatbelt
Falls
Poisoning
Fire safety
18 month anticipatory guidance
Return of separation anxiety, don't push your child into situations they are not comfortable with Set consistent limits to manage behavior Signs of toilet training; parental expectations New sibling on the way? Language development Reading Physical activity and safe play Nutritious foods Water, milk, and juice Express independence through food likes and dislikes Care safety Poisoning Sun protection Firearm safety Burns, fires Falls
24 month anticipatory guidance
IPV → National domestic violence hotline 800-799-SAFE (7233) Avoid the word “abuse” or “violence” Living situation and food safety Tobacco, alcohol, and drugs Parental well-being Development Temperment Encourage physical activity and safe play Communication skills Promote reading Toilet training, personal hygiene Car seat Safety: fire, falls, firearms
30 month anticipatory guidance
Day and evening routines Enjoyable family activities Parental activities outside family Consistency give choices Safety
months when dovemental screenings shoudl occur?
- 18, 24 (or 30 months)
when should specific autism screenings occur according to AAP?
18 and 24 months
what to do if child is positive for anemia?
risk factor screen at current visit and 6 months later
how old must you be in order to take tylenol?
12 weeks
max does of acetaminophen in 24 hours?
5
max daily dose of ibuprofen
40 mg/kg
Erikson stage for toddlers?
Autonomy vs. Shame and Doubt
